联合输注血制剂对创伤大量输血患者凝血功能的影响

Influence of combined infusion of blood products on blood coagulation,hospital stay and survival rates in traumatic patients with massive blood transfusion

目的:了解联合输注血制剂对创伤大量输血患者凝血功能及住院时间和生存率的影响。方法:将创伤患者大量输血前预防性联合输注血小板与冷沉淀凝血因子者设为联合组、输注血小板者设为对照A组、输注冷沉淀者设为对照B组。观察三组患者大量输血后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板(PLT)等凝血指标的变化情况及住院时间和生存率。结果:1三组患者术前一般资料及大量输血前凝血功能指标比较差异无统计学意义(P>0.05)。2联合组输血后PT、APTT、TT较输血前明显缩短(P<0.05),FIB、PLT明显增加(P<0.05);与对照A组比较,PT、APTT、TT明显缩短,FIB明显增加(P<0.05),与对照B组比较,PT、APTT、TT明显缩短,PLT明显增加(P<0.05);3三组入院后24h红细胞输注量差异无统计学意义(P>0.05);联合组血小板输注量少于对照A组(P<0.05),冷沉淀输注量少于对照B组(P<0.05)。联合组在住院时间上短于对照A组和对照B组(P<0.05)。结论:大量输血早期联合输注血小板与冷沉淀凝血因子可明显改善创伤患者的凝血功能,缩短住院时间。

Objective：To understand the influence of combined infusion of platelet and cryoprecipitate on blood coagulation,hospital stay and survival rates in traumatic patients with massive blood transfusion.Method：The traumatic patients with preventive combined infusion of platelet and cryoprecipitate before massive blood transfusion was set as the combined group,only infusion of apheresis platelet as control A group,only infusion of cryoprecipitate as control B group.Indicators of blood coagulation function such as prothrombin time（PT）,activated partial prothrombin time（APTT）,thrombin time（TT）,fibrinogen（FIB）and platelet（PLT）before and after blood transfusion were observed in three groups,and hospital stay and survival rates were observed.Result：①The general data such as gender,age,injury severity score（ISS）,preoperative coagulation index were compared in three groups,and there were no statistically significant difference（P〉0.05）.②PT,TT and APTT after combined infusion were significantly shorter than those before infusion in the combined group（P〈0.05）.FIB and PLT were significantly increased after the infusion in the combined group（P〈0.05）.PT,APTT and TT shortened obviously,FIB increased significantly in the combined group.When compared with those in control A group,the differences were statistically significant（P〈0.05）,and compared with control B group,PT,APTT,TT shortened obviously,PLT increased significantly,the differences were statistically significant（P〈0.05）.③Infusion quantity of red blood cells among 24 hafter admission was no statistical difference in three groups（P〉0.05）.Transfusion amount of platelets in combined group was less than that in control A group（P〈0.05）,and infusion amount of cryoprecipitate was less than that in control B group（P〈0.05）.The hospital stay in combined group was shorter than that in control A group and control B group（P〈0.05）.Conclusion：Early combined infusion platelet and cryoprecipitate before massive blood transfusion could obviously improve blood coagulation function in patients with trauma,and shorten the hospital stay.